Criteria-based audit to improve women-friendly care in maternity units in Malawi

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To assess and improve women-friendly care in maternity units in Malawi.


We interviewed 280 women about the care they received during childbirth at 29 different health centers. Results were compared with standards for women-friendly care, developed locally and based on evidence from World Health Organization manuals. The audit results were presented, and recommendations were made and implemented. A re-audit (involving 367 women) was conducted 3 months later.


Significant improvements were recorded on greeting clients (74.6 vs 87.7%; P < 0.001), respect for clients (91.1 vs 98.6%; P < 0.001), support by a companion during labor (58.9 vs 75.6%; P < 0.001), informing clients about different birthing positions (68.6 vs 79.3%; P = 0.002), allowing clients to adopt different birthing positions (67.9 vs 83.4%; P < 0.001), cleanliness of maternity wards (89.6 vs 97.0%; P < 0.001), speaking to clients using simple language (92.1 vs 98.6%; P < 0.001), ensuring privacy with curtains or screens (86.1 vs 92.1%; P < 0.012), and client willing to recommend the health facility to a friend (94.6 vs 98.6%; P = 0.004). However, there were no significant changes in the level of self-introduction by providers (62.5 vs 68.7%; P = 0.103) and provision of a clean bathroom and toilet (83.6 vs 80.4%; P = 0.282). Surprisingly, there was a significant deterioration in the use of linen to ensure privacy (86.4% vs 74.9%; P < 0.001). Overall, satisfaction of women increased by 9%.


The criteria-based audit was associated with an improvement in the quality of women-friendly care services in maternity units in Malawi.

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